Premature Ejaculation
DSM-III For more information, see Psychosexual Dysfunctions Diagnostic Criteria A'''. Ejaculation occurs before the individual wishes it, because of recurrent and persistent absence of reasonable voluntary control of ejaculation and orgasm during sexual activity. The judgment of "reasonable control" is made by the clinician's taking into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner, and the frequency and duration of coitus. '''B. The disturbance is not due to another mental disorder. DSM-IV For more information, see Sexual Dysfunctions Diagnostic Criteria A'''. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity. '''B. The disturbance causes marked distress or interpersonal difficulty. C'. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids). ''Specify type: * '''Lifelong Type * Acquired Type Specify type: * Generalized Type * Situational Type Specify: * Due to Psychological Factors * Due to Combined Factors Differential Diagnosis Erectile dysfunction related to the development of a general medical condition Premature Ejaculation should be distinguished from erectile dysfunction related to the development of a general medical condition. Some individuals with erectile dysfunction may omit their usual strategies for delaying orgasm. Others require prolonged noncoital stimulation to develop a degree or erection sufficient for intromission. In such individuals, sexual arousal may be so high that ejaculation occurs immediately. Occasional problems with premature ejaculation Occasional problems with premature ejaculation that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty do not qualify for the diagnosis of Premature Ejaculation. The clinician should also take into account the individual's age, overall sexual experience, recent sexual activity, and the novelty of the parter. Substance-Induced Sexual Dysfunction When problems with Premature Ejaculation are due exclusively to substance use (e.g., Opioid Withdrawal), a Substance-Induced Sexual Dysfunction can be diagnosed. DSM-5 Diagnostic Criteria A'. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it. ('Note: Although the diagnosis of premature (early) ejaculation may be applied to individuals engaged in nonvaginal sexual activities, specific duration criteria have not been established for these activities.) B'''. The symptom in Criterion A must have been present for at least 6 months and must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts). '''C. The symptom in Criterion A causes clinically significant distress in the individual. D'. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. ''Specify whether: * '''Lifelong: The disturbance has been present since the individual became sexually active. * Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: * Generalized: Not limited to certain types of stimulation, situations, or partners. * Situational: Only occurs with certain types of stimulation, situations, or partners. Specify current severity: * Mild: Ejaculation occurring within approximately 30 seconds to 1 minute of vaginal penetration. * Moderate: Ejaculation occurring within approximately 15-30 seconds of vaginal penetration. * Severe: Ejaculation occurring prior to sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration. Differential Diagnosis Substance/medication-induced sexual dysfunction When problems with premature ejaculation are due exclusively to substance use, intoxication, or withdrawal, substance/medication-induced sexual dysfunction should be diagnosed. Ejaculation concerns that do not meet diagnostic criteria It is necessary to identify males with normal ejaculatory latencies who desire longer ejaculatory latencies and males who have episodic premature (early) ejaculation (e.g., during the first sexual encounter with a new partner when a short ejaculatory latency may be common or normative). Neither of these situations would lead to a diagnosis of premature (early) ejaculation, even though these situations may be distressing to some males.